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The organisms of the human flora are the most common cause of bacteremia and sepsis in immunocompromised and bone marrow transplant (BMT) patients. Activities of daily living can lower the risk of infection by decreasing pathogenic bacteria on the skin and mouth.
Methods, Intervention, & Analysis
To address ADL compliance, a multidisciplinary team of both oncology and BMT units consisting of PCAs, RNs, nursing leadership and physicians was created. To improve compliance, the team adopted, the ADL 1-2-3 initiative: Daily bath/CHG bath, linen change, at least 2 activities per day, oral care 3 times per day. Using the Model of Improvement and through Plan Study Do Act (PDSA) testing we created a standardized ADL process that involved all providers. Interventions included addressing 1-2-3 compliance during rounds, creating accountability in care delivery, creation of an algorithm and order set for oral care, daily text message reminders, and physician intervention with non-compliant and high-risk patients.
Findings & Interpretation
Our baseline compliance with the 1-2-3 initiative was 25%. With our interventions we increased our median compliance to 66% in 90 days. The greatest impact on compliance was seen with text message reminders to staff to complete the 1-2-3 components, designated roles and responsibilities, and physician discussion with noncompliant and high-risk patients.
Discussion & Implications
Oral care algorithm and order set, daily text message reminders, and physician intervention with non-compliant and high-risk patients could all be adaptive to other units. Units where compliance with ADL participation is low would be an ideal environment to incorporate the ADL 1-2-3 initiative.